FORM 1023-EZ for DICKINSON COUNTY CISM TEAM INC

Field Data
EIN 82-3729040
Case Number EO-2018018-000279
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DICKINSON COUNTY CISM TEAM INC
Organization’s Mailing Address 612 MARKET STREET N
City LAKE PARK
State IA
ZIP 51347
Accounting period End 12
Primary contact name JOHN BJORNSTAD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEVEN HOPKINS
PRESIDENT
612 MARKET STREET N
LAKE PARK IA 51347

Officer/Director/Trustee Two

JEFF HANSON
VICE PRESIDENT
1302 31ST STREET
SPIRIT LAKE IA 51360

Officer/Director/Trustee Three

MILLY TILLOTSON
SECRETARY
1203 28TH STREET
SPIRIT LAKE IA 51360

Officer/Director/Trustee Four

DIANE ZEMPEL
TREASURER
4 24 TH STREET
SPIRIT LAKE IA 51360

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/17
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name STEVEN HOPKINS
Signature Title PRESIDENT
Signature Date 1/16/18

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